CONTROLLER’S OFFICE USE ONLY
BILLING METHOD (Term or Section): ______________________________ AR CODE _______________
REFUND POLICY ________________________________________________ AR CODE _______________
SECTION APPROVAL (*Required only if course fees are included)
DIVISION CHAIR ____________________________________________________ DATE ________________________
DEAN ______________________________________________________________ DATE ________________________
REGISTAR’S OFFICE ________________________________________________ DATE ________________________
BUDGET OFFICE ___________________________________________________ DATE ________________________
CONTROLLER’S OFFICE____________________________________________ DATE ________________________
**This form is to be used specifically for ALL Teacher In-Service sections (#3X, #4X)
which are currently authorized to bypass the Special Course Fee Procedures.
FORM DUE DATE – This form must be fully approved and received by the Controller’s Office at least one week prior to the section start date.
YEAR/TERM: _____________SUBJECT: _________________ COURSE #:________________ SECTION #:__________
TITLE: (26 characters max) ________________________________________________________CREDITS: ___________
SECTION DATES: START ___________ END __________ MEETING DATES: START _________ END __________
HIGH SCHOOL: ___________________________________________LOCATION:________________________________
BUILDING:____________ ROOM:______ START TIME:___________ END TIME:___________ DAYS:__________
CLASS CAP: _______ RESTRICTIONS: __________________________________________________________________
FACULTY: (printed legal) ________________________________________________ ID/SSN: ______________________
ADDITIONAL INSTRUCTOR INFORMATION (for brand new instructors)
MAILING ADDRESS: ____________________________ CITY: _______________________ STATE: ____ ZIP: _________
WORK PHONE: ____________________________________ HOME PHONE: _____________________________________
E-MAIL ADDRESS: ________________________________________________ DATE OF BIRTH_____________________
TEACHER IN-SERVICE SECTION APPROVAL FORM
